State Medicaid Programs Urgently Need to Prepare for the End of the COVID Public Health Emergency: These Tools and Resources Can Help
May 4, 2022
The COVID 19 Public Health Emergency (PHE) has been in effect since January 28, 2020. The original declaration lasted 90 days and has been extended repeatedly – but it won’t last forever. And the end of the PHE is going to cause serious upheaval in state Medicaid programs. The federal Centers for Medicare and Medicaid Services has been issuing guidance and toolkits to help states as they return to pre-pandemic enrollment and operations.
The COVID 19 Public Health Emergency (PHE) has been in effect since January 28, 2020. The original declaration lasted 90 days and has been extended repeatedly (in 90 day intervals) as the pandemic drags on. Most recently scheduled to end April 15, it’s just been extended again – but it won’t last forever. And the end of the PHE is going to cause serious upheaval in state Medicaid programs. As we explained last month, with the end of the PHE comes the end of the “maintenance of effort” requirement that prevented states from terminating any Medicaid beneficiary’s coverage. That means that states will be evaluating the eligibility of millions of beneficiaries. Even attempting this is a Herculean task – getting it right is going to be even harder. And, it is crucial that states do get it right, otherwise millions of people could wrongly lose their health care coverage, with potentially disastrous consequences.
The federal Centers for Medicare and Medicaid Services (CMS) has been issuing guidance and toolkits to help states as they return to pre-pandemic enrollment and operations (“undwinding”). That’s a good start – but advice from the feds is only part of what’s necessary. States will need all the help they can get to get this right. Luckily, many organizations in the non-profit and private sector are pitching in with advice. One valuable resource, developed by Princeton University and supported by the Robert Wood Johnson Foundation, is State Health and Value Strategies (SHVS). The site, which is intended to “assist states in their efforts to transform health and health care,” includes a “one-stop source of information for state officials” to support their planning for the unwinding. Unwinding topics include health equity, data and IT, eligibility and enrollment policy, consumer communications and outreach, and oversight and monitoring. The site also has a number of toolkits to support unwinding efforts.
One toolkit focuses on a crucial piece of the unwinding process – Medicaid managed care. As CMS notes, “Medicaid managed care organizations, providers, beneficiary advocates, and other stakeholders are critical to the resumption of renewals and other eligibility actions in a manner that supports retention of coverage. . .” That’s true, given that more than 50 million Medicaid beneficiaries (close to 70 percent of all beneficiaries ) are enrolled in managed care. Medicaid Managed Care Organizations (MCOs) will undoubtedly play a role in how well – or poorly – the unwinding goes.
The Leveraging Managed Care Plans to Support Medicaid Continuous Coverage Unwinding Toolkit, prepared by Manatt Health, offers strategies to use MCOs to support unwinding efforts. These include a combination of requiring plans to take certain steps and either relaxing restrictions on plans or simply providing assurances that MCOs aren’t forbidden from taking certain actions. For example, it advises states to require MCOs (through contracts) to obtain updated enrollee contact information and conduct outreach and provide support. It encourages states to allow MCOs to engage with applicants, for example, submitting applications and renewals on behalf of members. Finally, it encourages states to partner with MCOs to, for example, identify enrollees at high risk of not renewing coverage.
The PHE unwinding is fraught with risk for Medicaid beneficiaries. As CMS notes – states are going to need all hands on deck to reduce that risk. Hopefully, the many tools available can help.
This post was written by Sarah Somers, J.D., M.P.H., Managing Attorney, Network for Public Health Law – Southeastern Region Office.
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document do not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.
Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not represent the views of (and should not be attributed to) RWJF.